Cushing as an Innovator
Another area of serious concern, as Cushing observed the operating clinics in Europe and the United States, was the lack of good monitoring of the patient during surgery. Neurosurgical patients were not being evalu ated in regards to their general vital signs during the surgical procedure. There was no way to determine the general status of the patient as the anesthetic drug was exerting its effect, particularly in patients who had added complications or other morbidity factors, such as hemorrhage and cardiovascular pathology. A solution was increasingly evident, but was not incorporated until Cushing and his friend Ernest Amory Codman (1869-1940) introduced ether charts for general surgery cases at the Massachusetts General Hospital in 1894.6 Cushing introduced this in credibly innovative development into neurosurgical cases so that pulse, respirations and temperature were incorporated into the monitoring done in the neurosurgical operating room. The ether chart-an under estimated, practical and important prognostic tool-aided evaluation of patients undergoing long and exhaustive neurosurgical procedures.